3.06 Public Health:
Local Community Collaboratives
Supporting Public Health
- Examples from North Carolina
Holt Anderson, Executive Director
North Carolina Healthcare Information and
Communications Alliance, Inc. (NCHICA)
North Carolina Public Health Initiatives
• NC-PHIN
• NC-HAN
• NCEDD
• NCHESS
• NC PAiRS
• NCIR
• NC-PHIN
• North Carolina Public Health
Information Network
• NC-HAN
• North Carolina Health Alert Network
Characteristics of Projects
• All have evolved from earlier efforts
• All are statewide efforts
• All involve public and private sector
• All build toward a North Carolina “Local
Health Information Infrastructure” and are
positioned to connect into national PHIN
and NHII efforts
• Expectation is for continued evolution and
refinement
NC-PHIN
Vision: Framework for the Future
• Automated electronic reporting of data
• Secure Internet pipeline for reporting information
• Consistent user interfaces
• Common data definitions
• Reusable software components
• Shared analysis and dissemination methods, e.g.,
outbreak detection algorithms
• Secure, HIPAA-compliant data warehouse
• Established set of technical standards acceptable and
adopted by preparedness partners
NC-PHIN Components
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Health Alert Network NC-HAN
Epi-X (secure interactive
communications with CDC and
other states)
Enhanced Public Health
Surveillance
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Electronic Disease
Reporting
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Hospital Data (ICD-9, UB92
Admin. Data)
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Syndromic Surveillance
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Hospital Clinical Data
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Poison Control Center
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PreMIS
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Aberrancy Detection
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Medical Examiner Data
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Program Area Modules
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TB
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Hepatitis
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Meningitis
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HIV/STD
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Vaccine Preventable
Diseases
Immunization Registry
Multi-Hazard Threat Database
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GIS
Electronic Laboratory Results
(LRN)
Vital Records Automation
NC-PHIN Surveillance
“Protecting our Citizens - Moving to the Next Level”
• What health events are we trying to “sense”?
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–
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–
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Reportable diseases and conditions
Emerging infections and outbreaks (intentional or not)
Chemical (intentional or not)
Radiological (intentional or not)
Injuries
• What electronic data elements are needed to “sense”?
– Diagnosis
– Clinical symptoms/syndromes
– Related non-medical information
• Where do these data elements exist?
• How do we get them into PHIN?
NC-PHIN Public Health Regional Surveillance
Teams
5
4
1
6
7
Epi Lead
Nurse
Environmental
Admin
(Vet)
3
2
4 per team = 28 positions
North Carolina Health Alert Network - NC-HAN
• The NC-HAN is a secure, Web-based system
• Designed to automatically issue health alerts to
key individuals in :
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–
–
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The NC Division of Public Health
Local Health Departments
Hospitals
Laboratories, and
Other partners
• …in the event of bioterrorism or other public
health emergency.
NC-HAN Design
• The first piece in the NC Public Health Information Network
(PHIN), NC-HAN has met or exceeded all CDC
requirements.
• NC-HAN was designed to provide maximum flexibility to
allow for the addition of new user communities
• NC-HAN is designed to interface with the CDC National
Electronic Disease Surveillance System protocols.
• Both the NC-HAN system and database architectures allow
for expansion which reduces development time to include
new groups and organizations.
NC-HAN Operation
• NC-HAN operates on a 24x7 schedule with complete
system redundancy.
• NC-HAN users can issue an alert which automatically
contacts subscribed users by email, FAX, pager, and
voice until someone takes ownership of the event for
resolution.
• Only an alert number is issued. No confidential patient
or event information is transmitted.
• Only after the NC-HAN user logs into the secure system
can they obtain more detailed information about the
health alert and course of action.
NC-HAN Users to Date
Total to 8/1/2004:
• NC Division of Public Health:
• NC Dept. of Agriculture Users:
• 131 NC Hospitals:
• 85 Health Departments:
• Law Enforcement:
• Emergency Management:
984
78
27
173
692
5
9
NC-HAN Alerts To Date
122 HAN Alerts
Categories have included:
Smallpox
Influenza
Hepatitis A
Triple Play BT Exercise
SARS
Training
West Nile Virus
Measles
NC-HAN Future Enhancements
• Public Health Directory
• Surveillance Links (NEDSS, LIMS)
• Data Feeds
• Expanded User Manual - business rules for
partner utilization
• NCEDD
• North Carolina Emergency
Department Database
• NCHESS
• North Carolina Hospital Emergency
Surveillance System
Emergency Department Surveillance in
North Carolina
Analysis, Decision & Response
Standardization,
Analysis & Reporting
Data Collection
Background and Timeline
• 1998 – Emergency Physicians form Standardizing Electronic
Emergency Room Data (STEER) Work Group at NCHICA
• 1999 – CDC funds 3-year project to adopt DEEDS standard
and pilot collection and analysis of ED data – NC Emergency
Department Database Project (NCEDD) formed and
managed by UNC-CH Dept. of Emergency Medicine
• 2002 – NC Division of Public Health (NC DPH) funds
collection of data for public health BT surveillance purposes
• 2004 – NC Legislature mandates collection of data from NC
emergency rooms for public health surveillance purposes
• 2004 - NC DPH contracts with NC Hospital Association
(NCHA) to accelerate collection of data from all 112 EDs in
NC effective January 1, 2005
Technical Overview
• Hospitals securely FTP select data elements from
their information system(s) to NCEDD
• NCEDD standardizes and aggregates the data to
CDC’s Data Elements for Emergency Department
Systems (DEEDS) standard
• Data quality checks performed to remove
duplicates, check for out-of-range values and
unacceptable levels of missing data
• Provide Web-based reporting access to the data
Status
• Currently receiving data from 24 hospitals
– 4000 visit records per day on average (including both
new and updated records)
– Total Number of Visits:
928,266
– Total Number of Patients:
498,408
– Total Number of Final Diagnosis Codes: 2,654,323
– Total Number of Cause of Injury Codes:
315,043
Data Elements
• Patient & Visit IDs
• ED Disposition
• DOB, Sex, Race
• Vital Signs (when available)
• City, County, State, 5-digit ZIP
• ICD-9 Final Diagnosis and
• Arrival and Disposition
Date/Time
• Chief Complaint and Triage
Nurse Notes (when available)
• Triage Acuity Rating
• Transport Mode to ED
• Insurance Coverage
• Facility and Data Source
Injury (E) codes
• Procedure Codes
Data Users
• Public Health Epidemiologists (PHEs)
– In-hospital liaison to LHDs in NC’s 12 largest hospitals
– Perform in-hospital surveillance for communityacquired infections and for defined syndromes which
may be indicative of a terrorist attack
• NC Division of Public Health Epidemiologists
– Injury, Occupational Health, Cardiovascular
Epidemiology, among others…
• Local Health Directors
• Authorized users at participating hospitals
Reports Portal Basics
• Data are accessible 24/7/365 from any
Internet-ready computer using SSL
• Updates every morning
• Functionality offering report
customization
• Strictly defined user access controls
Report Selection Page
Aggregate Reports
Case Reports
Case Reports
Case Reports
North Carolina
Hospital Emergency Surveillance
System
(NCHESS)
NC Hospital Emergency Surveillance
System (NCHESS)
• Partnership with NC Hospital Association
• Mandatory reporting law for hospitals with
24-hour emergency rooms
• Near real time data
• Monitoring
• Investigation
• Begins to come online in January 2005
NCHESS Architecture Solution
Near
Real Time
Collection
MData
Solucient
Data
Processing
NC Hospital
Database
NCHESS
NCHESS
NCHESS
DATA
DATA
DATA
MMD
Real Time
Patient Level
Filter
& Alert
NCEDD
Investigate
Key
Monitor
Analyze
Detect
DPH Staff
Solucient\KB
Aberration
Detection
& Alert
Mercury MD
NCDPH /NCEDD
• NC PAiRS
• North Carolina Provider Access to
Immunization Registry Securely
• NCIR
• North Carolina Immunization Registry
Background and Timeline
• 1998 – Work group formed to develop project demonstrating
the secure use of the Internet to access clinical information.
Children's immunization records were selected and NCHICA
members volunteer to contribute to prototype development.
• 1999 – Initial demonstration sites online
• 2000 – Trial use of PKI technology not successful
• 2002 – NC reviews fully-functional registry technology
• 2004 - NC DPH awards contract for modification and
implementation of WI system in NC beginning in late 2004
NCHICA PAiRS PROjECT
PROVIDER ACCESS TO IMMUNIZATION REGISTRY SECURELY
Main Page
Search For Patient - Recommended Childhood Immunization Schedule
Tutorial - Policy Guidelines - Help Desk- Main Page
Please choose one of the following options:
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Search For Patient
Recommended Childhood Immunization Schedule
Tutorial
Policy Guidelines
Help Desk
IMPORTANT NOTES AND DISCLAIMERS
The immunization information furnished herein has been reported to the PAIRS demonstration project. There may be relevant events (e.g. other immunizations, adverse events) that have not
been reported to this authority. Clinical judgement should be used in reviewing the presented information in conjunction with any other information that may be available.
The information in this report may only be used or disclosed in accordance with NC Immunization Laws and Rules (G.S. 130A-153, G.S. 130A-155, G.S. 130A-155.1, 15A NCAC 19A .0406).
NCHICA PAiRS PROjECT
PROVIDER ACCESS TO IMMUNIZATION REGISTRY SECURELY
Search for Patient
Search For Patient - Recommended Childhood Immunization Schedule
Tutorial - Policy Guidelines - Help Desk- Main Page
LAST NAME*
FIRST NAME*
DATE OF BIRTH
[MM/DD/YYYY]*
MOTHER'S MAIDEN NAME
SOCIAL SECURITY NUMBER
[###-##-####]
MEDICAID NUMBER
MIDDLE NAME
ZIP CODE
Search for Patient
Clear
Fields marked with an asterisk (*) are required and must not be left empty.
IMPORTANT NOTES AND DISCLAIMERS
The immunization information furnished herein has been reported to the PAIRS demonstration project. There may be relevant events (e.g. other immunizations, adverse events) that have not
been reported to this authority. Clinical judgement should be used in reviewing the presented information in conjunction with any other information that may be available.
The information in this report may only be used or disclosed in accordance with NC Immunization Laws and Rules (G.S. 130A-153, G.S. 130A-155, G.S. 130A-155.1, 15A NCAC 19A .0406).
Users of the New Registry
The NCIR has been deemed to be exempt from the HIPAA Privacy Rule. North Carolina
Law requires the sharing of immunization information with the following parties:
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NC Department of Health and Human Services
•
•
•
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Local Health Departments
Physicians
Schools K-12
Colleges and Universities
•
•
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Licensed and registered childcare facilities
Head Start
Health Maintenance Organizations
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Other state and LHDs outside of NC
(NC public health law (N.C.G.S. 130A-153 c; 10A NCAC 41A .0406)
Features of New Registry
• Similar look and feel to PAiRS for users
• User-friendly, web-based system
• Helps to control vaccine-preventable diseases and identify
at-risk populations
• Serves as a clinical tool to identify and track children to allow
providers to maintain high immunization coverage
• Ability to view a patient’s immunization history and
automatically generate recommendations for current/future
doses
• Ability to generate automatic reminder/recall notices.
• Easy inventory management and on-line ordering of statesupplied vaccine
Benefits of the NC PAiRS Project
• Immediate and convenient access to records
by public AND private providers – good will!
• Experience with the Internet, security
methods, and Web access
• Expanded connections to private sector
• Prepared private sector for speedy
implementation of new registry
• Secure Internet connectivity can lead to other
PH applications such as automation of
mandatory reporting, HAN alerts, etc.
Thank you !
Questions ???
Holt Anderson, Executive Director
Holt@nchica.org
North Carolina Healthcare Information and
Communications Alliance, Inc. (NCHICA)
www.nchica.org